Traumatic pneumomediastinum: A risk factor for the development of pneumopericardium

Objective: Patients of polytrauma due to road traffic accident, fall from height, sports injury with blunt chest trauma, as well as penetrating injury to chest were investigated for pneumomediastinum and pneumopericardium, which may prove life threatening. Material and Methods: This study was retrospective for three years and prospective for three years and was conducted in the department of cardiovascular and thoracic surgery at the Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir for six years. All patients who reported to the hospital as polytrauma were investigated by noncontrast computed tomography (CT) scan of the chest. We did 1,350 CT scans of the chest for blunt and/or penetrating chest trauma in the last six years as a part of emergency investigations. All chest CT scans were investigated for pneumopericardium, simultaneous with other traumatic pathologies. Results: Of the 1,350 chest CT scans, 930 were normal. Twenty-one patients had pneumomediastinum in addition to other primary surgical pathology. Of these 21 patients with simultaneous pneumomediastinum, eight patients had associated pneumopericardium; five patients with pneumopericardium had blunt chest trauma as etiology and three patients had penetrating trauma as etiology for pneumopericardium. Conclusion: To overcome the fatality of pneumopericardium, two important approaches need to be followed. The first is continuous monitoring of blood pressure and the second is the availability of an immediate facility for drainage of pneumopericardium. Pneumomediastinum is obligatory for pneumopericardium to occur.